Djavan B, Marberger M
Department of Urology, University of Vienna, Austria.
Eur Urol. 1999;36(1):1-13. doi: 10.1159/000019919.
To assess whether the alpha1-adrenoceptor antagonists currently available for the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) (alfuzosin, terazosin, doxazosin and tamsulosin) can be distinguished with regard to clinical efficacy and/or tolerability.
Up-to-date analysis of clinical placebo-controlled or direct comparative studies with alpha1-adrenoceptor antagonists in patients with LUTS suggestive of BPO derived from a MEDLINE search in October 1998. All retrieved studies were analyzed with regard to efficacy and tolerability. Efficacy was evaluated by the percentage improvement in total symptom score and Qmax (mean end of study value relative to mean baseline value). Tolerability was evaluated by means of study withdrawal rate because of adverse events and the incidence of vasodilatatory adverse events (e.g. dizziness and orthostatic hypotension).
Indirect comparison of data derived from the placebo-controlled studies involving 6,333 patients and the data derived from the direct comparative studies involving 507 patients demonstrate that all alpha1-adrenoceptor antagonists (alfuzosin, terazosin, doxazosin and tamsulosin) produce comparable improvements in LUTS and urinary flow. Total symptom score is in general improved by 30-40% and Qmax by 16-25%. The difference between currently available alpha1-adrenoceptor antagonists is related to their side effect profile. Alfuzosin (especially the sustained release formulation) and tamsulosin (modified release formulation 0.4 mg) seem to be better tolerated than terazosin and doxazosin. The percentage of patients that withdrew due to bothersome side effects with alfuzosin and tamsulosin 0.4 mg was comparable to that with placebo (about 4-10%) whereas in the terazosin and doxazosin studies an additional 4-10% of patients dropped out because they did not tolerate the therapy. Tamsulosin has less effect on blood pressure than alfuzosin (especially in elderly patients) and causes less symptomatic orthostatic hypotension during orthostatic stress testing than terazosin.
All alpha1-adrenoceptor antagonists seem to have similar efficacy in improving symptoms and flow. The difference between alpha1-adrenoceptor antagonists is related to their side effect profile. Alfuzosin and tamsulosin appear to be better tolerated than doxazosin, terazosin and prazosin.
评估目前可用于治疗提示良性前列腺梗阻（BPO）的下尿路症状（LUTS）的α1肾上腺素能受体拮抗剂（阿夫唑嗪、特拉唑嗪、多沙唑嗪和坦索罗辛）在临床疗效和/或耐受性方面是否存在差异。
对1998年10月MEDLINE检索中有关提示BPO的LUTS患者使用α1肾上腺素能受体拮抗剂的临床安慰剂对照或直接比较研究进行最新分析。对所有检索到的研究进行疗效和耐受性分析。疗效通过总症状评分和最大尿流率（研究结束时的平均值相对于基线平均值）的改善百分比进行评估。耐受性通过因不良事件导致的研究退出率以及血管舒张性不良事件（如头晕和体位性低血压）的发生率进行评估。
对涉及6333名患者的安慰剂对照研究数据和涉及507名患者的直接比较研究数据进行间接比较表明，所有α1肾上腺素能受体拮抗剂（阿夫唑嗪、特拉唑嗪、多沙唑嗪和坦索罗辛）在改善LUTS和尿流方面具有相似的效果。总症状评分一般改善30% - 40%，最大尿流率改善16% -
25%。目前可用的α1肾上腺素能受体拮抗剂之间的差异与其副作用特征有关。阿夫唑嗪（尤其是缓释制剂）和坦索罗辛（0.4mg控释制剂）似乎比特拉唑嗪和多沙唑嗪耐受性更好。因令人烦恼的副作用而退出阿夫唑嗪和0.4mg坦索罗辛治疗的患者百分比与安慰剂组相当（约4% - 10%），而在特拉唑嗪和多沙唑嗪研究中，另外有4% - 10%的患者因不耐受治疗而退出。坦索罗辛对血压的影响小于阿夫唑嗪（尤其是老年患者），并且在体位性应激测试期间引起的体位性低血压症状比特拉唑嗪少。
所有α1肾上腺素能受体拮抗剂在改善症状和尿流方面似乎具有相似的疗效。α1肾上腺素能受体拮抗剂之间的差异与其副作用特征有关。阿夫唑嗪和坦索罗辛似乎比多沙唑嗪、特拉唑嗪和哌唑嗪耐受性更好。
